Provider Demographics
NPI:1235132705
Name:FELLER, STEVE R (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:R
Last Name:FELLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7507 CUSTER RD W
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8138
Mailing Address - Country:US
Mailing Address - Phone:253-472-6530
Mailing Address - Fax:253-472-6693
Practice Address - Street 1:7507 CUSTER RD W
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98499-8138
Practice Address - Country:US
Practice Address - Phone:253-472-6530
Practice Address - Fax:253-472-6693
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPOD0000317213ES0103X
WAPO0000317213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1037332Medicaid
WA480005031OtherRAILROAD MEDICARE
WA1037332Medicaid
WA0206610001Medicare NSC
WA480005031OtherRAILROAD MEDICARE